Confidential Intake Limited Enrollment

The Metabolic Health Kickstart

A structured 24-week metabolic health program built around your own lab data — not another diet. This questionnaire tells us where you are, and whether the program is something you'd qualify for right now.

Approx. 5 minutes · 7 sections

01 / 07

Section 01

Let's start with you

Everything you share here is confidential and goes only to the program lead. Nothing is shared, sold, or published.

First name *

Last name *

Email *

Mobile phone *

City

State * Enrollment is currently open in limited regions.

Age range * Participants must be 18 or older.

Who invited you, or how did you hear about this?

Section 02

Where you are right now

Check every statement that sounds like something you've actually said or thought. There are no wrong answers here — this is how we understand you.

Which of these sound like you? * Choose as many as apply.

"I've tried everything and nothing sticks." "I'm tired and just don't feel like myself." "My weight keeps creeping back up." "I want to know what's really happening inside my body." "I'm curious about GLP-1s but want professional guidance." "I don't want medication and want a natural option." "I need accountability and support." "I'm ready to finally make a real change for my health." None of these quite fit.

In your own words, what would you most like to change? * A sentence or two is plenty. This is the part we read first.

Section 03

Your goal and your history

Knowing what you've already tried keeps us from handing you the same thing again.

What is your single biggest goal right now? *

More energy — I want to feel like myself again Weight change that actually lasts Understanding my metabolic numbers — what's really going on inside Strength and consistent movement Nutrition structure I can live with Long-term health — getting ahead of what runs in my family

How long have you been working on this? *

Less than 3 months 3–12 months 1–5 years More than 5 years

What have you already tried? Choose as many as apply.

Diet or meal programs Tracking apps Gym membership or trainer Supplements on my own A medical weight-loss program Coaching or a group challenge Lab work through my provider Nothing structured yet

What usually gets in the way? Time, travel, schedule, motivation, cost, not knowing where to start — whatever is true for you.

Section 04

What the Kickstart actually involves

Read this before you answer. The program isn't right for everyone, and the next few questions are how we tell.

Program Specification

The Metabolic Health Kickstart

Length: 24 weeks, start to finish
Baseline: Lab testing and a Metabolic Health Score
Support: One-on-one health coaching throughout
Protocol: Targeted supplementation matched to your results
Tracking: Structured progress reviews against your baseline
Optional: A provider-guided GLP-1 pathway, available only if you're interested and an independent licensed medical provider determines you're eligible

Medication is never required. There is a complete non-medication pathway, and most of the program is identical either way.

The Kickstart is delivered in partnership with a third-party wellness company. Their identity, the full protocol, and pricing are shared privately during your consultation — see the confidentiality terms in Section 07.

How interested are you in lab testing and a Metabolic Health Score? *

1 2 3 4 5

Not interestedVery interested

Would you be comfortable completing a standard lab draw? *

Yes Maybe — I'd want to know what's tested first No, not right now

Where do you stand on the medication option? * There is no preferred answer. Eligibility for any medication is determined solely by an independent licensed medical provider — never by us.

I want the non-medication pathway only I'd be open to being evaluated by a licensed provider I'm already on a GLP-1 and want better support around it Not sure yet — I want to learn more before deciding

Would one-on-one health coaching be valuable to you? *

Yes, that's what I've been missing Maybe I'd rather have group support No, I prefer to work on my own

Section 05

Readiness and timing

Be honest here. This is what gets you matched to the right starting point instead of the biggest one.

The Kickstart runs 24 weeks. Can you commit to that window? *

Yes — I'm ready for a program that length Maybe — I'd need to see how it fits my life Not right now — something shorter makes more sense

Realistically, how many days a week can you give 20–30 minutes to your health? *

0–1 days 2–3 days 4–5 days 6–7 days

On a scale of 1–10, how ready are you to start? *

1 2 3 4 5 6 7 8 9 10

Just lookingReady today

When would you want to begin? *

This month In the next 30–60 days Later this year Just gathering information

Are you currently working with a provider or program on this? * Please don't share diagnoses or medical details here — a simple yes or no is all we need.

Yes No

Are you in a position to invest in a structured program right now? * We ask so we can point you to the right starting point. Every answer here has a real path attached to it.

Yes — I've set aside a budget for my health Yes, but I'd want to start smaller Not right now I'd rather not say

Section 06

How we reach you

A real person reviews every response and follows up within two business days.

What kind of support actually works for you? Choose as many as apply.

Daily check-ins A group community One-on-one coaching Weekly education and teaching Challenges and friendly competition Meal and movement structure Data, numbers and tracking Something family-centered

Best way to reach you *

Text message Phone call Email

Best time to reach you

Morning Midday Evening Weekends

Anything you'd want answered before you start?

Section 07

Confidentiality & acknowledgment

Please read before submitting. This protects your information and the program details shared with you.

1 · Mutual Confidentiality

Your information stays private. The Program Host identified at the end of these terms will treat your responses as confidential, and will use them only to evaluate program fit, prepare for a conversation with you, and support you if you enroll. Your responses are not sold, rented, traded, or published, and are not shared outside the Host's authorized team except as required by law or as necessary to enroll you in a program you have chosen.

The program details stay private too. In the course of your consultation or participation you may receive confidential information belonging to the Host or its partners — including the identity of the program sponsor and partner companies, protocols, curricula, assessments, lab panels, pricing, coaching frameworks, supplier relationships, and business processes ("Confidential Information"). You agree to keep Confidential Information in confidence, to use it solely for your own personal evaluation and participation, and not to copy, distribute, publish, post publicly, resell, or use it to build or operate a competing program without prior written consent. This obligation continues for two (2) years after your last contact with the Host, and indefinitely for anything constituting a trade secret under applicable law.

Confidential Information does not include information that is or becomes public through no fault of yours, that you already lawfully possessed, or that you independently develop without reference to it. Nothing here prevents you from discussing your own health, your own experience, or this program with your physician, your attorney, your family, or any government agency.

2 · Sponsor & Compensation Disclosure

The Kickstart is offered in partnership with an independent third-party wellness company (the "Sponsor"). The Host has a business relationship with the Sponsor and may receive compensation — including commissions — if you enroll or purchase products. The Sponsor's identity is not published here for business reasons, but you will be told exactly who the Sponsor is, what the program costs, and how the Host is compensated before you enroll, pay anything, or sign any agreement. If you would like that information now rather than at consultation, simply ask and it will be provided.

The Host is an independent operator and does not own, operate, or control the Sponsor, any medical provider, or any laboratory. Enrollment in the Sponsor's program is governed by the Sponsor's own terms, pricing, availability, and eligibility requirements.

3 · Not Medical Advice

This questionnaire is not a medical screening, diagnosis, or treatment recommendation. Nothing you receive from the Host or its coaches substitutes for care from a licensed healthcare provider, and no coach is acting as your physician or prescriber. Statements about any product have not been evaluated by the U.S. Food and Drug Administration, and no product or program is intended to diagnose, treat, cure, or prevent any disease.

Regarding GLP-1 and any prescription medication: the Host does not prescribe, dispense, recommend, or determine eligibility for any medication. Any decision about prescription therapy is made solely by an independent licensed medical provider following their own evaluation. Participation does not guarantee eligibility, approval, or access to any medication.

Please consult your own physician before beginning any nutrition, supplement, movement, or weight-management program — particularly if you are pregnant or nursing, are under medical supervision, or take prescription medication.

4 · No Guarantee of Results

Individual results vary and depend on factors outside anyone's control, including your consistency, starting point, and personal circumstances. Nothing here is a promise, warranty, or guarantee of any particular health, weight, income, or other outcome. Results shared by other participants are their own experience and are not typical.

5 · Your Responses Are Voluntary

Every question is answered at your discretion — share only what you're comfortable sharing. This form is not a HIPAA-covered medical record and is not encrypted end-to-end. Please do not use it to send diagnoses, medical records, test results, or identification numbers. You may request a copy of your responses, or ask for them to be deleted, at any time.

6 · Consent to Be Contacted

By submitting, you give express consent for the Host to contact you by phone call, text message, and email at the details you provided, to follow up on this questionnaire and share program information. Message and data rates may apply. Consent is not a condition of purchase. Opt out any time by replying STOP to a text, using the unsubscribe link in any email, or contacting the Host directly.

7 · General

This acknowledgment reflects the understanding between you and the Host regarding this questionnaire, and is governed by the laws of the State of Utah. If any provision is unenforceable, the remainder stays in effect. Enrollment in any specific program may require a separate agreement.

Program Host
Shaanta Kamai
(801) 980-1031 · sellbuyinvest@rehelpcenter.com

I have read and agree to the Confidentiality & Acknowledgment terms above, including the sponsor and compensation disclosure, that this is not medical advice, and that no results are guaranteed. * I consent to be contacted by phone, text, or email about my results and this program. * I confirm I am 18 years of age or older. *

Type your full name as your signature *

Date *

Your Result

What happens next

Your Program Contact Shaanta Kamai

(801) 980-1031 · sellbuyinvest@rehelpcenter.com

Reach out any time — including if you'd like the sponsor and pricing details before we talk.

A copy of your responses and the acknowledgment you signed has been sent to our team. Ask any time for a copy of your own, or to have it deleted.

The Metabolic Health Kickstart

These statements have not been evaluated by the Food and Drug Administration. This program is not intended to diagnose, treat, cure, or prevent any disease. Not medical advice. Individual results vary. Eligibility for any prescription therapy is determined solely by an independent licensed medical provider.